中性粒细胞胞外陷阱、炎性蛋白水平对全膝关节置换术后下肢深静脉血栓形成预测价值分析  

Analysis of the predictive value of neutrophil extracellular traps and inflammatory protein levels for lower extremity deep vein thrombosis after total knee arthroplasty

作　　者：郑桂莲[1] 耿晓慧[2] 张莎莎[3] 王茜 高文香[5] ZHENG Guilian;GENG Xiaohui;ZHANG Shasha;WANG Qian;GAO Wenxiang(Department of radiology,Henan Orthopaedic Hospital,Zhengzhou,Henan,450000,China;Renovation Department,Zhengzhou Hospital,Luoyang Bone-setting Hospital,Henan Orthopaedic Hospital,Zhengzhou,Henan,450000,China;Department of Laboratory,Luoyang Orthopaedic Hospital of Henan Province,Henan Orthopaedic Hospital,Zhengzhou,Henan 450000,China;ICU,Luoyang Orthopaedic Hospital of Henan Province,Henan Orthopaedic Hospital,Zhengzhou,Henan 450000,China;Department of Knee Joint Disease,Luoyang Orthopaedic Hospital of Henan Province,Henan Orthopaedic Hospital,Zhengzhou,Henan 450000,China)

机构地区：[1]河南省洛阳正骨医院、河南省骨科医院郑州院区放射科,河南郑州450000 [2]河南省洛阳正骨医院、河南省骨科医院郑州院区人工关节翻修科,河南郑州450000 [3]河南省洛阳正骨医院、河南省骨科医院检验科,河南郑州450000 [4]河南省洛阳正骨医院、河南省骨科医院ICU,河南郑州450000 [5]河南省洛阳正骨医院、河南省骨科医院膝关节病科,河南郑州450000

出　　处：《安徽医药》2022年第6期1128-1132,共5页Anhui Medical and Pharmaceutical Journal

基　　金：2015年河南省重点中医学科专科学术带头人培养项目专项课题(2015ZY03008)。

摘　　要：目的探究中性粒细胞胞外陷阱(NETs)、炎性蛋白水平对全膝关节置换术后下肢深静脉血栓形成(DVT)的预测价值。方法选取河南省洛阳正骨医院2018年1月至2019年6月全膝关节置换术病人110例,根据是否伴有DVT分为观察组36例(DVT病人)及对照组74例(无DVT病人)。比较两组术前、术后1 d、术后3 d血清NETs(吸光度)、炎性蛋白[C反应蛋白(CRP)、巨噬细胞炎性蛋白1α(MIP-1α)]水平,logistic回归分析全膝关节置换术后下肢DVT的影响因素,受试者工作特征(ROC)曲线分析血清NETs、CRP、MIP-1α对下肢DVT的预测价值。结果两组年龄、体质量指数(BMI)、合并内科疾病比例差异有统计学意义(P<0.05);观察组术后1 d、术后3 d血清NETs[(0.52±0.16)、(0.26±0.08)]、CRP[(35.27±11.74)mg/L、(19.64±6.55)mg/L]、MIP-1α[(38.09±12.68)ng/L、(21.07±7.02)ng/L]水平高于对照组[(0.38±0.13)、(0.37±0.13)]、[(25.28±8.42)mg/L、(13.16±4.37)mg/L]、[(26.63±8.84)ng/L、(15.22±5.10)ng/L],均差异有统计学意义(P<0.05);年龄、合并内科疾病、BMI、术后3 d血清NETs、CRP、MIP-1α水平是全膝关节置换术后下肢DVT的重要影响因素(P<0.05);各指标预测术后下肢DVT的ROC曲线结果显示,术后3 d血清CRP预测下肢DVT的灵敏度最高(0.833),而术后3 d联合检测预测下肢DVT的特异度、准确度、约登指数和AUC值最高,分别为0.784、0.791、0.590、0.883。结论NETs、CRP、MIP-1α在全膝关节置换术后DVT病人中呈高表达,与DVT发生显著相关,并对DVT发生具有一定的预测价值,尤其是三者联合检测具有更高的预测效能,靶向NETs、CRP、MIP1α可能为防治DVT提供了一个新思路。Objective To investigate the predictive value of neutrophil extracellular traps(NETs)and inflammatory protein levels on lower extremity deep vein thrombosis(DVT)after total knee arthroplasty.Methods A total of 110 patients with total knee arthroplasty from January 2018 to June 2019 at Luoyang Orthopaedic Hospital in Henan Province were selected and divided into 36 cases in the observation group(patients with DVT)and 74 cases in the control group(patients without DVT)according to whether they were accompanied by DVT.The levels of serum NETs(absorbance),inflammatory proteins[C-reactive protein(CRP),macrophage inflammatory protein 1α(MIP-1α)]before,1 d and 3 d after surgery were compared between the two groups,and the factors influencing DVT formation after total knee arthroplasty were analyzed by logistic regression,and the subject operating characteristic(ROC)curves were analyzed for serum NETs,CRP,and MIP-1αon DVT The predictive value of DVT formation.Results There were statistically significant differences in age,body mass index(BMI),and proportion of comorbid medical diseases between the two groups(P<0.05).The levels of serum NETs[(0.52±0.16),(0.26±0.08)],CRP[(35.27±11.74)mg/L,(19.64±6.55)mg/L],and MIP-1α[(38.09±12.68)ng/L,(21.07±7.02)ng/L]in the observation group at 1 d and 3 d postoperatively were higher than those in the control group[(0.38±0.13),(0.37±0.13)],[(25.28±8.42)mg/L,(13.16±4.37)mg/L],[(26.63±8.84)ng/L,(15.22±5.10)ng/L],with statistically significant differences(P<0.05).Age,comorbid medical disease,BMI,and serum NETs,CRP,and MIP-1αlevels at 3 d postoperatively were significant influencing factors for DVT formation after total knee arthroplasty(P<0.05).The results of ROC curves for each index to predict postoperative DVT formation showed that serum CRP at 3 d postoperatively had the highest sensitivity(0.833)in predicting DVT formation,while the combined assay at 3 d postoperatively had the highest specificity,accuracy,Jorden index,and AUC values of 0.784,0.791,0.590,and 0.883,respe

关 键 词：静脉血栓形成 关节成形术 置换 膝 手术后并发症 下肢 中性粒细胞胞外陷阱 C反应蛋白质 巨噬细胞炎性蛋白1Α 

分 类 号：R687.4[医药卫生—骨科学] R543.6[医药卫生—外科学]